How has the archetypal concept of drug addiction based on the model of physical tolerance, craving, and withdrawal been undermined by social and psychological research? The concept addiction in relation to narcotic and alcohol use is often seen as an intrinsic part of drug abuse especially opiates, in particular Heroin. One is lead to believe by the media and drug awareness schemes that ‘physical and psychological dependence upon heroin is likely to occur’1 as a result of trying Heroin. The negative withdrawal systems of coming off Heroin are also well publicised with abstinence from the drug bringing such symptoms ‘as chronic diarrhoea, muscle cramps, vomiting, insomnia, sweating, anxiety, and tremors’2.
As a society we are warned about the negative social effects that Heroin users bring in particular the crimes they commit to maintain their habits. Heroin use has long been associated with crime because its importation and distribution are illegal and because many addicted people turn to theft and prostitution to obtain money to buy the drug. In addition, violent competition between drug dealers has resulted in many murders and the deaths of innocent bystanders.
From 1979 through 1990 arrests for heroin manufacture, sale, or possession in the United States held steady, but in the 1990s arrests rose as the drug’s popularity began to increase once more3. Due to the extensive reporting on the physically addictive nature of Heroin, the bleak list of withdrawal symptoms, the notion of building up a tolerance (possibly resorting to crime) other factors remained unquestioned due to our preconceptions and assumptions of addiction when it comes to looking at the reality of Heroin addiction and addictions to other substances.
The first time that we can consider the term ‘addiction’ regarding substance abuse is within the disease model. The disease model did not originally appear with narcotics but with alcohol. Harry Levine in his article ‘The Discovery of Addiction’ suggests that ‘During the 17th century, and for most of the 18th, the assumption was that people drank and got drunk because they wanted to, and not because they “had” to. In colonial thought, alcohol did not permanently disable the will; it was not addicting, and habitual drunkenness was not regarded as a disease’4.
Levine points out that the notion of addiction did not come about til ‘the end of the 18th century and in the early years of the l9th when some Americans began to report for the first time that they were addicted to alcohol: They said they experienced overwhelming and irresistible desires for liquor. Laymen and physicians associated with the newly created temperance organizations developed theories about addiction and brought the experience of it to public attention’5.
Essential redefinitions of both alcohol and narcotic addiction came about at the turn of the twentieth century. The term “alcoholic” was accepted as a popular designation for the chronic inebriate in this century after the founding of Alcoholics Anonymous. Dr William Silkworth ‘endeavoured to show that alcohol does not become a problem to every person who uses it, and that the use of alcohol in itself does not produce a chronic alcoholic Of those who are able to drink with impunity, however, a certain number will sooner or later develop this anaphylactic condition, in which the tissue cells are sensitized to alcohol’6. The Silkworth/Wilson model of alcoholism became a very popular, aided by the National committee for education on Alcoholism.
This modern version of the disease theory of alcoholism thus conceived of alcoholism as a danger for only a small group of afflicted biologically predestined individuals. However Stanton Peele (1984) argues ‘Despite this drawback, the disease theory of alcoholism-that uncontrolled drinking is inbred and irreversible- it became the banner of Alcoholics Anonymous, itself a continuation of the self-help alcoholism movements of the previous century. By the latter half of the twentieth century, with both AA and the American medical establishment embracing it, the disease theory became orthodoxy in the US and across western Europe’7.
In the latter part of the twentieth century, the disease model began to be criticised even more by both sociologists and medics alike. B. D Hore (1991) is sceptical about the disease model suggesting the main criticisms of labelling alcoholism as a disease is that doing so it removes responsibility from the individual for his or her own condition, it could foster an unwillingness on the part of individuals to pay attention to their symptoms in the early stages of an alcohol problem and tends to encourage perpetuation of the notion of an irreversible drinking pattern.
D Beauchamp (1980) suggests that ‘the disease model is not a reliable model for alcohol problems and must become more detailed and complex by including reference to such factors as: culture and legal restraints, economic variables, and social contexts that directly shape drinking behaviour. This shift in emphasis will still permit us to speak of the individual consequences of heavy alcohol consumption, including addiction and other disabilities’9. The divergent histories and differing contemporary visions of alcohol and narcotics in the United States and many other western countries have produced two different versions of the addiction concept.
Whereas narcotics have been considered to be universally addictive, the modern disease concept of alcoholism has emphasized a genetic susceptibility that predisposes only some individuals to become addicted to alcohol. A concept that aims to describe the full reality of addiction must incorporate non-biological factors as essential ingredients in addiction-up to and including the appearance of craving, withdrawal, and tolerance effects.
However, there have been other models of dependency which can be said to relate to narcotic abuse rather than alcoholism. If one looks at Heroin, one can see that many of the withdrawal symptoms can be seen to be the exact opposite of the drug itself. Heroin can be said to be euphoric, analgesic and relaxing but after withdrawing the addict is often left dysphonic, in great pain and grossly agitated. Due to these unsavoury side effects one can apply the physical model of dependence. Withdrawal effects are unpleasant and reduction in these effects would therefore constitute negative reinforcement .
Negative reinforcement is the reinforcement of behaviour that terminates an aversive stimulus] Negative reinforcement could explain why addicts continue to take the drug. However some addicts will endure withdrawal symptoms ( go ‘cold-turkey’) in order to reduce their tolerance so that they can recommence drug intake at a lower dose which costs less to purchase. However, concentrating on the role of physical withdrawal effects at the expense of other psychological factors led to the failure to recognize the addictive properties of cocaine.
Cocaine does not produce physical dependency (tolerance and withdrawal symptoms) but people are often said to be addicted to Cocaine. It is also important to emphasize that reduction in withdrawal symptoms does not explain why people take drugs in the first place. Negative reinforcement may account for initial drug taking in some situations. For example, someone who is suffering from unpleasant emotions may experience a reduction in these feelings (i.e. negative reinforcement) following drug administration.
Another explanation of drug addiction is the Positive reinforcement model. According to J. Stewart (1987) ‘Positive reinforcers produce motivational effects that outlast their presentation. These appetitive motivational consequences are reflected in post-incentive behaviours such as locomotion and exploration of the environment, repeated visits to a place associated with the presentation of the incentive, and activation of learned behaviours in the presence of stimuli previously associated with the incentive event’10. This means that if somebody were to have a positive experience due to using a drug they will be more likely to use it again.